| NPI | 1215956024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA op00002026) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX L0103) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2011-12-21 |